Median Time from ED Arrival to ED Departure for Admitted ED Patients

Last updated: May 17, 2016

CMS Measure ID: CMS55v4
Version: 4
NQF Number: 0495
Measure Description:

Median time from emergency department admission to time of discharge from the emergency room for patients admitted to the facility from the emergency department.

Initial Patient Population:

Inpatient Encounters ending during the measurement period with Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days.

Measure Population:

Inpatient Encounters preceded by an emergency department visit.

Measure Observations:

Time (in minutes) from ED admission to ED discharge for patients admitted to the facility from the emergency department.

Denominator Statement:

Not Applicable

Denominator Exclusions:

Not Applicable

Numerator Statement:

Not Applicable

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Not Applicable

Measure Steward: Centers for Medicare & Medicaid Services
Domain: Person and Caregiver-Centered Experience Outcomes
Short Name: ED1
Next Version: Median Time from ED Arrival to ED Departure for Admitted ED Patients
Previous Version: Median Time from ED Arrival to ED Departure for Admitted ED Patients
Measure Score: Continuous Variable
Improvement Notation:

Improvement noted as a decrease in the median value

Guidance:

This measure specification defines how to determine the duration of an individual Emergency Department encounter. Reporting requires the median of all ED encounter durations defined as [Encounter: encounter ED] discharge date and time minus [Encounter: encounter ED] ED admission date and time.

Calculate the ED time in minutes for each person in the measure population; report the median time for all calculations performed. The specification provides elements from the clinical electronic record required to calculate for each ED encounter, i.e., the length of time the patient was in the Emergency Department, also stated as: the Datetime difference between the Emergency Department discharge time and the Emergency Department admission time. The calculation requires the median across all ED encounter durations.

For each population, results should be reported without stratification and then with each stratum applied. For this measure, the number of encounters that fall into the Initial Population are reported without stratification, then reported according to the defined stratification. The number of encounters that fall into the Measure Population are reported without stratification, then reported according to the defined stratification. The computed continuous variable defined by the Measure Observation is reported for the Measure Population also, then reported according to the defined stratification.

Specifications

Release Notes

Header

  • Clarified that the Initial Population consists of the inpatient encounters ending during the measurement period with length of stay (Discharge DateTime minus Admission DateTime) less than or equal to 120 days.
  • Copyright updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • Guidance was improved to clarify that the duration of the ED Encounter is defined as [Encounter: encounter ED] admission discharge date and time minus [Encounter: encounter ED] ED discharge admission date and time.
  • Measure Population description was refined to more accurately reflect the logic of the measure.
  • Reporting stratum modified to include the use of principal diagnoses. Workflow practices regarding the assignment of principal diagnoses may affect the function of this measure.
  • Stratification 1 in the prior version of the measure was removed because it was redundant with the measure population. Strata have been renumbered to reflect this update.
  • The rate aggregation description was clarified to explain that measure observation is made on the duration the patient was in the Emergency Department after the decision to admit, also stated as: the Datetime difference between the Emergency Department discharge time and the Decision to Admit time.

Logic

  • Clarified the Measure Population for emergency department visits where an inpatient encounter did not start within 119 minutes of the discharge from the emergency department. Use of <= 1 (hour(s)) operator means the difference between the end of the Emergency Department visit and the beginning of the Inpatient visit needs to be less than or equal 1 hour which spans from 0 to 119 minutes and 59 seconds.
  • ED encounter admission and discharge timestamps are used instead of facility location arrival and departure timestamps for timing comparison logic.
  • For each population, results should be reported without stratification and then with each stratum applied. For this measure, the number of encounters that fall into the Initial Population are reported without stratification, then reported according to the defined stratification. The number of encounters that fall into the Measure Population are reported without stratification, then reported according to the defined stratification. The computed continuous variable defined by the Measure Observation is reported for the Measure Population also, then reported according to the defined stratification.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions and/or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced variable $EncounterInpatient to allow re-use of logical expressions and reduce redundancy/complexity.
  • Replaced DateDiff or TimeDiff functions with Datetime difference in the measure observation section, and removed 'AND' operators from the statements underneath the DateTimeDiff function.

Value Sets

  • Psychiatric/Mental Health Patient Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.299): Deleted 21 SNOMED codes and 52 ICD10CM codes, and added 75 SNOMED codes.

External Resources